Healthcare Provider Details

I. General information

NPI: 1003335191
Provider Name (Legal Business Name): AVIGHNA RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BEDFORD PARK BLVD E
BRONX NY
10468-1771
US

IV. Provider business mailing address

7 BEDFORD PARK BLVD E
BRONX NY
10468-1771
US

V. Phone/Fax

Practice location:
  • Phone: 718-975-4411
  • Fax: 718-975-4413
Mailing address:
  • Phone: 718-975-4411
  • Fax: 718-975-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number035850
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SRIKANTH CHAMAKURA
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 718-975-4411